Boston College doctoral student Ryan Thombs is the lead author of a research article on the forces the behind the country’s growing drug overdose rate, recently published in the Journal of Health and Social Behavior. The article, "What Is Driving the Drug Overdose Epidemic in the United States?,” is based on research Thombs, a Ph.D. student in BC’s Sociology Department, conducted with his co-authors Dennis Thombs (University of North Texas); Boston College Sociology Professor and Chair Andrew Jorgenson, and Taylor Harris Braswell (Northeastern University).
Thombs was asked by the journal's editor to write a policy brief for the research article, and he was interviewed about the study for the journal's podcast series—a distinction reserved for only one article in each issue of the journal.
In 2017, 70,237 drug overdose deaths occurred in the United States, with about two out of three of these deaths involving opioids.
Ryan Thombs
“The sheer magnitude of the epidemic and its harmful impacts on people across the U.S. made it an important issue for us to explore,” said Ryan Thombs in the journal’s podcast. Published by the American Sociological Association, the Journal of Health and Social Behavior is one of the leading health journals in the social sciences.
Although drug-related mortality has been increasing in this country for nearly 20 years, there is no consensus about its causes.
Thombs and the research team used data from 50 U.S. states and the District of Columbia covering the 2006 to 2017 period to evaluate three theories to explain the drug overdose epidemic.
The demand-side perspective argues that the drug overdose epidemic is a consequence of changes in the economy that leave behind working-class people who lack a college education. In contrast, the supply-side perspective maintains that the epidemic is primarily due to drugs—particularly opioids—becoming more readily available and affordable through both licit and illicit means. A third, distinct perspective argues that income inequality plays more than an ancillary role in shaping the drug epidemic.
The researchers examined three key variables in their statistical analysis: educational attainment (the percentage of the state population with a bachelor’s degree), the opioid prescription rate, and four different measures of income inequality.
Contrary to the demand-side approach, the researchers found that educational attainment was not associated with drug-related mortality. In support of the supply-side approach, they found evidence indicating that opioid prescription rates are associated with drug-related mortality.
“We also find that income inequality is a key driver of the epidemic, particularly the lack of resources going to the bottom 20 percent of earners,” said Thombs.
In fact, said Thombs, the income inequality perspective is a way to incorporate insights from both the demand-side approach and the supply-side approach, which are often positioned as competing paradigms.
“The results of this study have important implications for understanding the drivers of the U.S. drug overdose epidemic and the policies needed to combat it,” said Thombs.
The researchers suggest that an adequate response to the drug epidemic requires not only limiting the availability of opioids but also redistributing income, particularly to the bottom 20 percent of earners.
“We suggest that policymakers should strengthen regulations to restrict the manufacturing, distribution, and prescription of legal opioid medication,” Thombs said in the podcast. “However, given the availability of low-cost and illegal opioids, addressing structural issues like income inequality will also be key to reducing drug-related demand and mortality.”
Kathleen Sullivan | University Communications | November 2020